Please complete the form below

Before starting any workplace workout programme with Chirp we need to know a little bit about you and if you have any injuries or special conditions. Please take the time to complete the below.

 
Name *
Name
Please enter the name of your employer / company
How regularly do you currently exercise? *
Have you ever done yoga or pilates before?
Terms & Conditions *
I confirm and agree that the following terms and conditions and undertakings apply to the Workplace Work out (Yoga and/or Pilates Exercises or Meditation) to be provided to me by Chirp. I have been examined by a licensed medical practitioner (“Practitioner”) within the past six months and have been found by such Practitioner able to perform all vigorous stretching and the Yoga and/or Pilates Exercises, which I am to perform during my workplace workout with Chirp. I will faithfully follow all instructions given to me by Chirp and its teachers as to when, where, and how to perform and not to perform the exercises. I agree and acknowledge that participation in any Yoga and/or Pilates Exercises could constitute a risk of serious injury to myself, including permanent paralysis or death. I voluntarily and knowingly recognise, accept and assume this risk a warrant that I am physically fit and able to perform the Yoga and/or Pilates Exercises without risking serious injury, including permanent paralysis or death. I acknowledge that neither Chirp, its owners, teachers or employees shall be nor be deemed to be responsible or liable (whether in contract or in tort or under any statute whatsoever), for any injury, illness or other mishap I sustain arising from or out of, or in any way directly or indirectly connected with the Yoga and/or Pilates Exercises. I understand and acknowledge that I am to receive instruction in Yoga and/or Pilates Exercises and theory only. Chirp, its owners, teachers or employees are not liable for, nor expected to provide any advice, training or medical assistance other than in the form of the Yoga and/or Pilates Exercises and/or Meditation. I indemnify and will at all times hereafter well and sufficiently indemnify and keep fully indemnified Chirp, its owners, teachers, representatives or employees from and against all actions, suits, causes of action, proceedings, claims, costs and expenses whatsoever which may be taken or made against Chirp, its owners, teachers, representatives or employees incurred or become payable by Chirp , its owners, teachers or employees of Chirp in connection with or arising out of any such injury, illness or mishap to me.